Knowledge of HIV Status is on the Rise

According to guidelines by the Centers for Disease Control and Prevention (CDC), we all should have been tested for HIV at least once in our lives. The National HIV/AIDS Strategy (NHAS) includes, as one of its key priorities, widespread HIV testing to help increase the number of people living with HIV who know their status, improve their health, and reduce new HIV infections. The NHAS sets a target for increasing the percentage of people living with HIV who know their serostatus to at least 90% by 2020. Data released in the CDC’s July 2017 Monitoring Report [PDF 2.3MB] show that, in 2014, 85% of people living with HIV in the U.S. knew their status, which exceeds the NHAS annual target.

Getting tested and knowing your HIV serostatus are entry points to either the HIV prevention continuum or the HIV care continuum. If you test negative for the virus, knowing the results allows you to take steps—like using condoms, taking PrEP, and limiting risky behaviors—that can help you stay negative.

If you are living with HIV, knowledge of your serostatus is essential to accessing and receiving the medical care and support services you need to stay healthy and live a long life. People who are diagnosed early and stay virally suppressed can live almost as long as a peer who does not have HIV. In addition, recent trials of HIV treatment-as-prevention found no cases of HIV infection that were linked to someone who was virally suppressed.

In the 2017 Monitoring Report, CDC used a new method for calculating the percentage of people living with HIV who are aware of their infection. The new method resulted in a lower estimate of the total number of people living with HIV. The new estimate for 2014 is 1.1 million people living with HIV, rather than the 1.2 million that had been previously reported. As a result, data and NHAS annual targets from 2010 to 2014 were updated. You may also notice that the percentage reported previously for knowledge of serostatus is slightly lower than what was presented with the old method. More information on this new method can be found in the Monitoring Report [PDF 2.3MB].

The new data show that 6 of 7 people living with HIV in 2014 knew their status. From 2010 to 2014, the percentage of people living with HIV who had been diagnosed and were aware of their serostatus increased from 82.7% to 85%. Consistent improvement was seen from year to year, and the 2014 target (84.5%) was exceeded. This continued a trend begun in previous years for reaching the annual targets, and movement continues to head toward achieving the NHAS 2020 targets.

However, the data available from 2014 for age, sex, race/ethnicity, and transmission category show that differences in the knowledge of serostatus continue. While women, those older than age 34, whites, heterosexual females, and those who inject drugs met the annual target, several subgroups failed to meet the overall annual target of 84.5% for knowledge of serostatus among people living with HIV. They included:

• Sex: 84.2% of males knew their serostatus.
• Age Group: Among those aged 13-24, 55.6% knew their HIV status. Among those aged 25-34 years, 70.9% did.
• Race/Ethnicity: Only whites achieved the annual target (87.7%). All other race/ethnicity categories fell below the annual target.
• Transmission Category: 80.7% of heterosexual males and 82.7% of men who have sex with men knew their HIV status.

While these subgroups did not achieve the annual target, the proportion of people in each subgroup who are aware of their HIV status increased between 2010 and 2014. This indicates we are moving in the right direction.

Overall, the Monitoring Report provided good news and showed that the progress we saw in earlier years has continued—which moves us closer to our 2020 NHAS target of 90%. This progress has been made possible because of large-scale, federally funded efforts to provide access to HIV testing, as well as state and locally funded programs and testing provided as part of health insurance. For example, in 2012, the U.S. Department of Health and Human Services and the U.S. Department of Veterans Affairs provided more than 9,160,000 HIV tests.

The data also reveal that, in 2014, about 15% (166,000) of people living with HIV in the U.S. were undiagnosed and were therefore at risk of developing HIV-related illnesses and transmitting the virus if they engaged in high-risk sexual behavior.

There is a critically important need to reach more of these individuals—particularly through strategies that reach those with a recently acquired HIV infection. We have to continue to provide testing to those who have never been tested, as well as to encourage repeat testing among those at increased risk.

Many federal agencies, state and local health departments, community health centers and other healthcare systems, and community-based organizations are engaged in activities to provide more people with testing, increase repeat testing in high-risk populations, and to make sure that those diagnosed with the virus are linked to prompt, ongoing HIV care. Read more about what they are doing.

In the next post in our continuing series about the NHAS Indicators, we will look at the indicator for new HIV diagnoses. Stay tuned…